Corrections GI 3 Flashcards
What 2 investigations are contraindicated in ulcerative colitis in the acute setting?
1) colonscopy
2) barium enema
due to risk of bowel perforation
What barium enema findings would you expect to see in ulcerative colitis?
- lead-piping inflammation (2ary to loss of haustral markings)
- thumb-printing (a marker of bowel wall inflammation)
- pseudopolyps (due to areas of ulcerating mucosa adjacent to areas of regenerating mucosa)
Cause of pseudopolyps in UC?
Due to areas of ulcerating mucosa adjacent to areas of regenerating mucosa.
Cause of lead-pipe appearance on barium enema in UC?
2ary to loss of haustral markings
What is the first line medical treatment to maintain remission in Crohns?
Azathioprine or mercaptopurine
What neurological complications can be seen in coeliac disease? (3)
1) Loss of balance: ataxia, loss of coordination, falls
2) Sensory symptoms: numbness in glove and stocking distribution
3) Headaches
Cause of loss of balance in coeliac?
Gluten ataxia
Cause of sensory symptoms in coeliac?
Gluten neuropathy
Cause of headaches in coeliac?
Gluten encephalopathy
Management of gastroparesis (3)?
1) Diet e.g. low fibre, smaller/more frequent meals
2) 1st line: domperidone (dopamine receptor antagonist)
3) 2nd line: metoclopramide or erythromycin (motility agents)
What are the management options in a peri-anal abscess?
IV Abx, examination under anaesthetic with incision and drainage
What are the extra-intestinal signs of Crohn’s disease?
1) Erythema nodosum
2) Arthritis
3) Gallstones
4) Renal stones
5) Ocular: anterior uveitis & episcleritis
Which type of inflammatory bowel disease are non-caseating granulomas seen in?
Crohn’s
What is the initial medical management of a severe flare of ulcerative colitis?
Admit to hospital for IV steroids and rehydration
What is the cause of Gilbert syndrome?
Reduced activity of UDP glucuronosyltransferase (the hepatic enzyme responsible for conjugation of bilirubin) resulting in indirect hyperbilirubinemia.
Which alternative serological test can be performed if IgA anti-TTG is weakly positive in coeliac disease?
Anti EMA
hat is the inheritance pattern of haemochromatosis? (1)
What gene is affected? (1)
Autosomal recessive
Human haemachromatosis protein (HFE) gene
What medication is used for diarrhoea symptoms in irritable bowel syndrome? (1)
Loperamide
What is the usual screening test for Helicobacter pylori infection in the community? (1)
Stool antigen test
What medications are used to manage hepatic encephalopathy? (2)
1) Lactulose (aiming for 2-3 soft stools daily)
2) Abx, usually rifaximin
What scoring system is used to assess the severity of liver cirrhosis and the prognosis? (1)
Child Pugh score
What are the top genetic diseases that cause liver cirrhosis? (3)
Haemachromatosis
Wilson’s
A1AT deficiency
What is the inheritance pattern of alpha-1 antitrypsin deficiency? (1)
What gene is affected? (1)
Autosomal co-dominant
SERPINA1 gene coding for alpha-1 antitrypsin on chromosome 14
Which hepatitis B marker is used to screen for active infection? (1)
Surface antigen HBsAg